== Biosecurity Commons Review May 2010 Outline Excerpt on Global Pandemic ==

””’Link to Full Report””’ []
””’Chapter 2 Global Pandemic and Asset Allocation””’

””Brian J. Gorman and Jennifer Kallal””

””’1. Introduction””’.

” The recent swine flu scare revealed unexpected problems with asset acquisition and deployment.  ”’…”’
Chief among these being whether or not governments should reduce the risk of relying on private enterprise for prophylaxis and increase harmonization of pandemic response efforts for the benefit of all nations.”

””’2. Private Sector Prophylaxis Supply”’.”
” ”’…”’One lesson learned was that the wealthiest of countries can face unexpected shortages of prophylaxis if international suppliers breach contracts for much needed supplies.  Another lesson learned was that the discretionary power of private business can hold sway over a limited and essential supply of prophylaxis in the global market.  …  Thus, the best public health planning can far too easily be undermined by unexpected factors.”

” ”’A. Government Prophylaxis Production”’.  A feasibility study may be warranted to determine whether or not the U.S. government should establish vaccine manufacture facilities.  The study should evaluate the cost/risk/benefit ratios of directly operating production facilities or going into partnerships with domestic manufacturers.  ”’…””’

” ”’B. Amend International Private Laws Governing Prophylaxis Supply for Public Health Crises”’.  In the absence of domestic production of vaccines it would be wise to revisit international laws governing prophylaxis supply during a public health emergency.  ”’…””’
” If the U.S. continues to rely on foreign vaccine manufacturers, greater legal protections may need to be put in place.  While the U.S. may choose a forum in the United States for litigation over a contract with a foreign manufacturer, it may not prove helpful if time is of the essence, specific performance is demanded, or an award of damages and financial penalties is used to compel compliance if the foreign company operates beyond the reach of U.S. authority.  Thus, the U.S. and other countries importing vaccine supply for epidemic or pandemic may want to revisit substantive laws under the United Nations Convention on Contracts for the International Sale of Goods (1980) (hereinafter CISG).  ”’…””’

””’3. Global Harmonization of Pandemic Response Efforts”’.
The consequences of failing to harmonize pandemic response efforts were also made apparent through the H1N1 flu crisis.  ”’…””’

” The negative effect this time around was short-lived criticism from a number of international stakeholders.    However, the global reaction to this situation is likely to be far worse in the face of a pandemic with high morbidity rates.  U.S. interests are so dependent on the international cooperation of partners in business and security, that the backlash from the perception that the U.S. is intentionally super-dosing and reducing the global supply of vaccine for political reasons rather than clinically justifiable reasons must be carefully considered.”

” ”’A.  International Health Regulations (2005)”’.  ”’…””’
” ”’…”’ The question remains whether future revisions could embrace agreed upon priorities detailing responses and duties of those holding prophylactic assets during a highly morbid pandemic.
Debate in this area will likely address several issues affecting the nexus of domestic and international public health policies.  Questions include whether or not States Parties can agree to meet certain protocols, priorities, and duties in planning and responding to global pandemic.”

” For instance, issues include whether or not States Parties could agree to:

”a.) Use minimal dosage of prophylaxis to further global supplies.”

”b.) Use any and all safe practices to increase the supply of prophylaxis”.

”c.) Refrain from interfering with the export of prophylaxis supply.”

”d.) Assure highest docketing priority and expeditious civil procedure for the immediate enforcement of contract provisions in jurisdictions chosen to host contractual disputes over prophylaxis supply.”

”e.) Agree to contribute a designated percentage of prophylaxis supply to countries in need.”

”f.) Make good faith efforts to contribute to the delivery of prophylaxis to countries in need.”
”4. Dual-Benefit Strategies.””

” ”’…”’A paradigm shift from an open competition for a limited supply of prophylaxis to one of global partnership using a dual benefit strategy will not be easy.  Policy debates on these questions will no doubt be extensive since they straddle the delicate issues of sovereignty, security, and resources.  …”

”’A. Public Health Security by Maintaining the Strength of Global Partners”’.  …
” Without implementing dual benefit strategies to assist global partners in developing countries, the U.S. and other wealthy countries run the risk of incurring higher rates of infection that typically afflicts countries with far less resources.   Thus, lack of access to prophylaxis in developing countries is not only a moral issue, but it should be recognized as a priority for all stakeholders since global prophylaxis is directly related to the financial well being, personal health, and security of all U.S. citizens.
”An analysis of national pandemic preparedness plans has exposed that very little consideration is given to providing for the needs of developing nations.  If these plans are not changed to help meet the necessities of the most impoverished who face the greatest risk, than the U.S. runs the risk of getting hit with a pandemic of even greater force than need be.”

””’B. Vaccine Distribution”’.  Vaccine distribution in developing countries is an acute if not intractable problem.  …”

””’C. Efforts to Strengthen Global Partners in Pandemic”’. …Maintaining reliance on current policies that result in mere transfers of excess supplies to developing countries may prove costly in a highly morbid pandemic.   The question is whether or not stakeholders take advantage of the rare glimpse into the dynamics of the genuine pandemic crisis of 2009 to modify policies, agreements, and laws in the best interests of all stakeholders.”
””’Link to Full Report””’ []

== ”Status Brief” ==
”’Developmental Milestones/Developments to Date:”’
”’Current Assessment/State of the Field:”’

== Web Resources ==
”’Health & Human Services Pandemic Influenza Plan Supp 4”’ []
”’Department of Defense Influenza [[Pandemic]] Preparation and Response Health Policy Guidance”’ []
* [[Flu]], [[Homeland Security]]
”’Department of Health and Human Servies”’, “Local Pandemic Influenza Preparedness: Vaccine and Antiviral Drug Distribution and Dispensing”, September, 2009.[]

*In a 2008 review of State pandemic influenza operating plans the Assistant Secretary for Preparedness and Response (ASPR) stated that states were “doing well” with [[vaccination]] plans.
*The Department of Health and Human Services (HHS) provided states with guidelines for planning vaccine distributions
*The 8 planning areas outlined are: Receiving & Staging, Dispensing, Tracking, Vulnerable Populations, Priority Groups, Security, Storage, and Transportation.
*”Selected localities had not addressed in their planning documents most of the vaccine and antiviral drug distribution and dispensing components and preparedness items identified in HHS pandemic influenza guidance.”
*”All selected localities conducted exercises related to vaccine and antiviral drug distribution and dispensing; however most did not create After Action Reports and Improvement Plans for these exercises.”
*”All selected localities collaborated with community partners to develop and exercise their plans to distribute and dispense vaccines and antiviral drugs during an influenza pandemic.”
*The HHS provided several recommendations in this article.
*[[Homeland Security]], [[Flu]]

== 2003 ==

”’Blakely, Debra”’, “Social Construction of Three Influenza Pandemics in The New York Times”, Journalism & Mass Communication Quartery, Vol. 80, No. 4, 2003, pg. 884-902.
* “This study looked at three influenza pandemics and examined the social construction of influenza over time.”
* “Using 835 New York Times articles, the study demonstrated that the social construction of influenza did change over time and that these changes were reflected in public-health policy frames.”
* “This research demonstrates how the popularization of science changed the social construction of disease in America.”
* [[Flu]]
”’Osterholm, Michael T”’.,”[[SARS]]: How effective is the state and local response?”, Hearing before the Permanent Subcommittee on Investigations, May 2003, pgs 14-16.
*”There is a critical need for our country to prepare its homeland security against human-made and Mother Nature-made biological attacks.”
*”There is a growing threat of emerging infections and use of biologic agents as a form of terrorism.”
*”Federal agencies such as the Department of Heath and Human Services, and Department of [[Homeland Security]] have been responding to such threats.”
*”The United States has fortunately been lucky as compared to places like Toronto, [[Canada]], who has seen the worst of the SARS Pandemic.”
*Their country is experiencing impacts on mortality rates, as well as economic and social impacts.”
*”SARS is a disease transmitted via respiratory route that has now seeded itself in a sufficient number of humans which could make elimination impossible.”
*”It is imperative that we coordinate the roles of Federal, State and local agencies.”
*”We also need to understand the capabilities of our health care delivery systems and the private sector in responding to this problem.”

== 2004 ==
”’Marley, Chad., et al”’., “SARS and its impact on current and future emergency department”, The Journal of Emergency Medicine, Vol. 26, No. 4, pg. 415-420, 2004.
*”Concern of new pathogens to the United States became real during the migration of the West Nile Virus in the summer of 2002, and was accentuated by the unexpected emergence of Severe Acute Respiratory Syndrome (SARS).
*”As of October 2003,SARS has afflicted more than 8000 individuals and caused 774 deaths worldwide.”
*”Since the emergence and progression of SARS and similar epidemics have occurred rapidly, printed medical journals have been increasingly challenged to keep pace with developments, and health care professionals are now increasingly utilizing the World Wide Web for up-to-date information.”
*”SARS is the first new disease to necessitate involuntary quarantine measures in the United States since 1983.”
*There have been successes have occurred in controlling the SARS epidemic despite the lack of specific details; primarily through general health measures and coordinated public health policies.”
== 2005 ==
”’Lowell, Jennifer”’, “Identifying Sources of Human Exposure to Plague”. Journal of Clinical Microbiology. Pg. 650-656. Vol. 43, No. 2.
*”Approximately 3,000 human cases occur worldwide annually, with 12 to 15 cases reported each year in the western United States”
*”Two of the primary objectives of routine epidemiology plague investigations are to identify the source of human exposure and to assess the exposure site for potential continuing risk.”
*”The use of molecular epidemiological techniques in these investigations has been particularly difficult for Y. pestis because of its apparent lack of genetic variation.”
*”When combined with epidemiologic information, judicious use of genetic data from nonhuman organisms is highly attractive because of the power of DNA-based analyses to identify exposure sources.”
*[[Public Health]], [[Pandemic]], [[Plague]], [[Decontamination]], [[Biodetection]], [[Bioterrorism]], [[Biodefense]], [[Biosafety]]

”’Taubenberger, Jeffery K., et. al.”’, “Characterization of the 1918 influenza virus polymerase genes,” Nature Publishing Group, vol. 437. October 6, 2005, pg. 889-893.
*”Unlike the 1957 and 1968 pandemics, however, the 1918 virus was mostly not a human/ avian reassortant virus, but rather an avian-like virus that adapted to humans ”in toto”.”
*[[1918 Flu]], [[Flu]], [[Pandemic]]
* ”Note: This article has been cited 246 times as of October 5, 2009 as recorded by the Web of Science”.
”’Kaiser, Jocelyn”’, “Resurrected Influenza Virus Yields Secrets of Deadly 1918 Pandemic”, Science, Vol. 310, 7 October 2005, page 28-29.
*“The research grows out of Armed Forces Institute of Pathology (AFIP) pathologist Jeffery Taubenberger’s efforts, begun in 1995, to sequence the genome of the 1918 flu virus. Working mainly with tissue from a victim found in permafrost in Alaska, he and others have been piecing together the virus’s eight genes and characterizing their protein products.”
*“Because of the sensitive nature of the work, the Centers for Disease Control and Prevention (CDC) lab’s safety precautions received unusual scrutiny, says Tumpey, including review by several biosafety committees. Workers followed biosafety level 3 (BSL-3) practices, with additional enhancements for instance, wearing battery-powered air purifiers with face shields and showering when leaving the lab.”
*“A new federal biosecurity board gave the paper an unusual last-minute review to make sure the merits of its publication outweighed the risks of releasing potentially dangerous knowledge. The board’s green light is a relief to scientists who have worried about a clampdown on scientific information following the anthrax attacks.”
*“Science decided to publish the 1918 flu paper because it ‘could help prevent another global flu pandemic,’ says Editor-in-Chief Donald Kennedy.”
*[[1918 Flu]], [[Biosafety]], [[Dual Use]], [[Biosecurity]], [[Pandemic]]

== 2006 ==
”’Mosquera, Mary”’, “DHS To Develop Biosurveillance System For Pandemic,” Tech News (GCN), May 12, 2006.
*”The Homeland Security Department expects to award a contract in mid-summer to develop the National Biosurveillance Integration System, a critical piece of the administrations strategy yo handle a [[pandemic]], such as the avian [[flu]].”
*”The biosurveillance system will aggregate and integrate information from food, agricultural, [[Public Health]] and environmental monitoring and the intelligence community from federal and state agencies and private sources to provide an early warning system for an outbreak or possible [[bioterrorism]] attack.”
*”The biosurveillance system will also send back to its system partner agencies completed situational awareness in real-time streams.”
*”Information will come from sources such as the Centers for Disease Control and Prevention BioSense system, which reports [[Syndromic Surveillance]] from hospitals and pharmacies, and the BioWatch system, which monitors aerosols for biothreat agents in major metropolitan areas.”
”’McKenna, Maryn”’” ANATOMY OF A PANDEMIC: EMERGENCY DEPARTMENTS WOEFULLY UNPREPARED FOR BIRD FLU OUTBREAK,” Annals of Emergency Medicine Volume  48, September 2006.
*Avian [[Flu]]

”’Brundage, John”’, “Cases and Deaths During Influenza Pandemics in the United States”, American Journal of Preventive Medicine, Volume 31, pg. 252-256, 2006.
*Estimates of the nature, magnitude, and impact of the 1918–1919 influenza pandemic inform plans for responding to the next pandemic.
*The“W-shaped” relationship between case fatality rates and age and the sharp peak of deaths among previously healthy young adults are of particular interest.
*In a future pandemic the death rates due to influenza will be different than the 1918 pandemic due to larger proportions of middle-aged and elderly adults.
*This suggests that the pandemic will target adults older than 30 rather than the younger population.

== 2007 ==
*“The Spanish flu pandemic of 1918–1919 emerged killing an estimated 50 million people. Humans are still being assailed by infectious disease threats. In the past five years alone, several pathogens were seen in North America for the first time – West Nile virus, monkeypox virus, low pathogenic avian flu in commercial bird farms, mad cow disease and Severe Acute Respiratory Syndrome (SARS).” (Pg. 2)
*“several researchers have called for stricter controls over biotechnology experimentation that provide dual-use information and technologies, dissemination of bioinformatics data and regulation of researchers as a way to manage infectious disease risks” (Pg. 2)
*“Emerging diseases can be controlled but doing so requires significant funding and a coordinated effort. Implementation of strategies such as modern ‘ring containment’ where infectious disease was cordoned off by vaccinating individuals in a circle surrounding outbreak areas, and hospital quarantine under controlled conditions eradicated smallpox from the planet.” (Pg. 2)
*“Genetic engineering is defined as the process of manipulating the pattern of proteins in an organism by altering its existing genes. Since the genetic code is similar in all species, genes taken from one organism can function in another, allowing traits to be altered or introduced. Either new genes are added, or existing genes are changed so that they are produced by the recombinant.” (Pg. 3)
*“With 30,000 human gene targets, available biotechnologies, and scientific creativity just about any gene can be turned into a bioweapon target.16 The problem then becomes one of risk issue management as we try, as a society, to mitigate the risks of subverted uses of biotechnology.” (Pg. 3)
*“We have reached a point through science and communication technology where we can detect, track and contain most emerging diseases in real time, no longer passive victims from the assault of infectious diseases.” (Pg. 6)
*[[Bioterrorism]], [[Pandemic]], [[Emergency Response]], [[Public Health]]
”’Zimmerman, Richard”’, “Rationing of influenza vaccine during a pandemic: Ethical analyses”, Vaccine, 25, 2007, pg. 2019–2026.
* “Rationing of scarce vaccine supplies will likely be required when the next pandemic occurs, raising the questions about how to ration and upon what principles.”
* ” Since influenza pandemics have differing mortality patterns, such as the 1918 pandemic’s “W” shaped curve that effected healthy young adults, the particular pattern should inform rationing.”
* “ethical principles for vaccine rationing can be utilitarianism and egalitarianism.”
* “A framework that uses multiple principles to address influenza vaccine rationing in light of a shortage is recommended.”
*[[Vaccination]], [[Ethics]], [[Pandemic]], [[1918 Flu]], [[Flu]]
”’McNeill Jr., Donald, G.”’., “U.S. Issues Guidelines on Use of Face Masks in Flu Outbreak,” NYT, May 4, 2007.
* Little scientific data proving masks help/[[CDC]]/feds building mask stockpile/Gerberding/other countries’ plan rely on masks more heavily/option only for sick/sloppy changing of infected masks may increase transmission in certain situations

== 2008 ==

”’Garoon, Joshua P., Duggan, Patrick S”’., “Discourses of disease, discourses of disadvantage: A critical analysis of National [[Pandemic]] Influenza Preparedness Plans,” Social Science & Medicine, 67, 2008 1133–1142.
* “The threat of pandemic influenza to global health has led to increased emphasis on pandemic influenza preparedness planning. Previous analysis of national pandemic preparedness plans has revealed that those plans paid scant attention to the needs and interests of the disadvantaged. This paper investigates those findings via critical discourse analysis of the same plans as well as World Health Organization guidance documents. The analysis reveals that the texts operate within and as parts of an ordered universe of discourse.Unless the plans recognize their discursive construction,implementation of the policies and practices they prescribe runs the risk of further disadvantaging those very populations most likely to require protection.
* [[Flu]], [[Ethics]]
”’McNeill Jr., Donald, G”’., NYT, January 22, 2008, D1 (continued D8) “A Pandemic That Wasn’t but Might Be,” –[[Flu]], [[Vaccination]] /preparations/better vaccine/European Center for Disease Prevention and Control, Stockholm/poor countries/faster lab tests/international/recommend vaccinating millions.
”’Grimaldi, Christine”’, “Avian [[Flu]] Pandemic Could Cost United States Billions,” CQ Homeland Security, Jan. 18, 2008.
*Mere seasonal flu kills 36,000 per year, costs $37.5 billion and 111 million work days.
”’Oshitani, Hitoshi, Kamigaki, Taro, Suzuki, Akira”’,  “Major Issues and Challenges of Influenza Pandemic Preparedness in [[Developing Countries]].” Emerg Infect Dis. 2008 June; 14(6): 875–880. []
*”Deaths attributable to an influenza pandemic could be substantially higher in developing countries than in industrialized countries. Pharmaceutical interventions such as vaccines and antiviral agents are less likely to be available in developing countries.”
*” The most critical limiting factor for stockpiling of neuraminidase inhibitors in developing countries is their high cost. One treatment course of oseltamivir (i.e., 10 tablets) costs US $15, even at a discount rate (16), which is far too expensive for developing countries. Some industrialized countries have set a target to stockpile oseltamivir to treat 25% of the general population. To purchase adequate oseltamivir for 25% of the total population, only 0.11% of the total annual health expenditure is required in high-income countries. In low-income countries, however, the expense would be 12.9% of the annual expenditure (Table 1). Therefore, it is not feasible for low-income countries to allocate scarce resources to stockpile sufficient quantities of oseltamivir for an unpredictable in[[flu]]enza pandemic.” [[Vaccination]]
”’Poltzer, Patrice”’, “Tuberculosis: A New Pandemic?”, CNN, November 17, 2008.
* “TB mutating into dangerous new strains for which there is no known cure”
* XDR-TB = a drug-resistant TB, incurable, could lead to a pandemic, airborne disease,
* 40,000 new cases of XDR-TB each year – WHO
* disease primarily affects developing nations
* TB is curable but if drugs not administered or used, disease can mutate into strands like XDR
* strong link between TB and poverty
*[[Developing Countries]], [[Tuberculosis]], [[Vaccination]], [[Public Health]]
”’Spring, Manda”’, “Bio-Surveillance and Pandemic Surveillance, What’s The Difference?,”, Dec. 12, 2008.
*”Bio-surveillance is the technique of tracking communicable diseases such as STDs, salmonellosis, and streptococcal infections.”
*”This program requires information on the patient such as location, age, gender, race, and other specifics designed to create a demographic portrait of the current victim(s) and potential victims.”
*”[[Pandemic]] surveillance is much like Bio-surveillance in the technological aspects.  Details about victims are stored in a data base and monitored, tracking the transmission and extent of contagion over time.”
*”Disease control and pandemic/epidemic prevention are becoming easier with Bio-surveillance and Pandemic surveillance technology.”
*”Knowing when the next outbreak may start or what group may be affected allows the time for specialists to intervene before the outbreak can spread.”

”’Ortu, Giuseppina, Mounier-Jack, Sandra, Coker, Richard”’, “Pandemic influenza preparedness in [[Africa]] is a profound challenge for an already distressed region: analysis of national preparedness plans,” Health Policy and Planning 2008 23(3):161-169. []
*”Thirty-five of 53 African countries now have national strategic pandemic influenza preparedness plans.
*Many plans are developmental in nature, and although they place particular emphasis on early detection of animal outbreak and early containment of animal outbreaks, attention to human containment is less developed.
*The health care sector is ill-prepared for pandemic influenza, and contingency planning for essential services is largely absent from plans.
*Operational planning is almost entirely absent from countries’ plans for pandemic in[[flu]]enza.”

== 2009 ==
”’Verweij, Marcel”’, “Health Inequities In Times Of A Pandemic”, PUBLIC HEALTH ETHICS, Volume 2, Issue 3, pgs 207-209, 2009.
* people in low-income countries may have no access to vaccination despite being more vulnerable to the significant negative effects of H1N1
* “Australia, Canada, and the Netherlands expect to have sufficient vaccines to immunise the whole population”
*[[Ethics]], [[Developing Countries]], [[Flu]], [[Vaccination]], [[Public Health]]
”’Collin, Nicolas, de Radiguès, Xavier”’, “Vaccine production capacity for seasonal and Pandemic (H1N1) 2009 influenza,” Vaccine 27 (2009) 5184–5186.
*the World Health Organization H1N1 Vaccine Task Force
*”[[WHO]] carried out a survey in May 2009 among influenza vaccine manufacturers on their planned seasonal and pandemic production with a view to developing recommendations on the distribution and use of pandemic influenza vaccine.”
*”The potential output of 4.9 B doses of pandemic vaccine per year reported in the present survey is a best-case scenario.”
*”theWHODirector-General, Dr. Margaret Chan, and the United Nations Secretary-General, Mr Ban Ki-moon, met with senior officials of vaccine manufacturers on 19 May to ask them to reserve part of their production capacity for poor countries with no or little access to pandemic vaccine”
*[[Flu]], [[Vaccination]]
”’Franco-Paredes, Carlos, Carrasco, Peter, Preciado, Jose Ignacio Santos”’, “The first influenza pandemic in the new millennium: lessons earned hitherto for current control efforts and overall pandemic preparedness,” Journal of Immune Based Therapies and Vaccines, 2009, 7:2, [],
*“it has become clear that responding to the current pandemic or preparing for future ones, nation states need to develop or strengthen their laboratory capability for influenza diagnosis as well as begin preparing their vaccine/antiviral deployment plans. Vaccine deployment plans are the critical missing link in pandemic preparedness and response. Rapid containment efforts are not effective and instead mitigation efforts should lead pandemic control efforts.” [[vaccination]], Flu
”’Dearne, Karen”’, “Real-Time Data Vital In Flu Fight,” The Australian, Finance Section, pg. 25, May 5, 2009.
*”‘If there is an e-health infrastructure, we have the potential to deal with disease outbreaks before they become [[pandemic]]s.'”
*”Once doctors, hospitals, labs and researchers are all using e-health software, it becomes possible to automatically analyze patient records or medical processes to identify risks, flag alerts and speed up diagnostic or treatment responses.”
*”‘You need a way of capturing data across medical specialties at a central point so you can detect threats early enough to allow time to develop therapies and reduce the risk of a pandemic…We need to be able to share this information across borders and as close to real-time as we can get.'”
*[[Flu]], [[Biosurveillance]]
”’Ryerson-Cruz, Geraldine”’, “As Flu Pandemic Declared, Leaders Must Focus On Poor Countries To Avert Bleaker Picture”, WORLDVISION.ORG, June 11, 2009.
* Africa and Central America
* “With limited access to health services, extreme poverty, high malnutrition rates, and the slower-burning pandemics of HIV and AIDS, tuberculosis, and malaria already stretching society’s coping mechanisms, the poor are more at risk than the general population,” said Stefan Germann, World Vision International’s Geneva-based director for global health partnerships.
*[[Developing Countries]], [[Flu]], [[Public Health]]
”’Department of Health and Human Servies”’, “Local Pandemic Influenza Preparedness: Vaccine and Antiviral Drug Distribution and Dispensing”, September, 2009
*In a 2008 review of State pandemic influenza operating plans the Assistant Secretary for Preparedness and Response (ASPR) stated that states were “doing well” with [[vaccination]] plans.
*The Department of Health and Human Services (HHS) provided states with guidelines for planning vaccine distributions
*The 8 planning areas outlined are: Receiving & Staging, Dispensing, Tracking, Vulnerable Populations, Priority Groups, Security, Storage, and Transportation.
*”Selected localities had not addressed in their planning documents most of the vaccine and antiviral drug distribution and dispensing components and preparedness items identified in HHS pandemic influenza guidance.”
*”All selected localities conducted exercises related to vaccine and antiviral drug distribution and dispensing; however most did not create After Action Reports and Improvement Plans for these exercises.”
*”All selected localities collaborated with community partners to develop and exercise their plans to distribute and dispense vaccines and antiviral drugs during an influenza pandemic.”
*The HHS provided several recommendations in this article.
*[[Homeland Security]], [[Flu]]
”’Yamada, Tadataka”’, “Poverty, Wealth, and Access to Pandemic Influenza Vaccines”, THE NEW ENGLAND JOURNAL OF MEDICINE. September 17, 2009. Volume 361, Number 12, pgs. 1129-1131.,
*do developing countries have the manufacturing capacity, cost, and delivery systems and resources available to get vaccines?
*only a few countries in the world have plants for manufacturing influenza vaccine and 3 companies account for most of the world’s manufacturing capacity: GlaxoKlineSmith, Sanofi-Aventis, and Novartis.
* problem- “much if not most of the manufacturing capacity is already spoken for through purchasing contracts held by many of the world’s wealthy countries.”
* steps to ensure global community has vaccinations: identify strategies and mechanisms to make vaccines more accessible
* [[Developing Countries]], [[Flu]], [[Vaccination]], [[Public Health]], [[Ethics]]
“Swine Flu Pandemic Will Reveal 21st Century’s Poverty Pandemic”, GLOBAL HEALTH POLICY AT NYU-WAGNER, Sept 27, 2009.
* historically influenza not an “equal opportunity” disease
* “people with coexisting conditions are more susceptible to poor health outcomes” and “most developng countries have high incidence of malnourished children and adults with many coexisting medical conditions.”
* socioeconomic factors- “poor resources for clean water and sanitation, no health care system or inadequate resources to seek medical attention”
* [[Ethics]], [[ Flu]], [[Developing Countries]], [[Vaccination]], [[Public Health]]
”’Somerville, Margaret”’, “A world of competing sorrows; There’s a flu pandemic and health-care resources are scarce. How do we decide who lives and who dies?” The Globe and Mail ([[Canada]]), Pg. A17, July 16, 2009.
*”H1N1 flu presents us with what we call in [[ethics]] “a world of competing sorrows” – that is, one in which there is no response that does only good and not also harm.”
*”How do we decide who gets a chance to live and who dies, when those outcomes depend on who gets access to or is denied scarce health-care resources? Who should decide? On what basis? Using which processes? The H1N1 influenza pandemic raises a large cluster of such ethical issues.”
* [[Flu]], [[Vaccination]]
”’Suk, Jonathan,”’, “Wealth, Inequality, and Tuberculosis Elimination in Europe”, EMERGING INFECTIOUS DISEASES, Volume 15, No. 11, November 2009.
* Europe- wealth inequality directly related to TB
* “decline of TB incidence in Europe preceded the advent of anti-TB drugs and coincided with rapid improvement of quality of life”
* “the current financial crisis could exacerbate the conditions of existing vulnerable groups as well as create new ones”
* [[Tuberculosis]], [[Public Health]], [[Europe]]

== 2010 ==
*“Since 2001, the U.S. government has devoted considerable time and effort identifying potential vulnerabilities to biological attacks, promoting prevention strategies, and anticipating how best to respond should a large-scale biological attack ever occur.” (Pg. 2)
*““The more that sophisticated capabilities, including genetic engineering and gene synthesis, spread around the globe, the greater the potential that terrorists will use them to develop biological weapons . . . . Prevention alone is not sufficient, and a robust system for public health preparedness and response is vital to the nation’s security.’” (Pg. 3)
*“The changes generally grant broad sweeping powers to state governors and health officials, including the power to order forced treatment and vaccination without specifying which exemptions….Such changes could increase the chances for state abuse of power and lead to confusion during a mass vaccination campaign.” (Pg. 3)
*“Currently, the federal government lacks authority to exert control over a state’s emergency vaccination plans, regardless of whether the plans are too lenient and severely risk the public’s health or too rigid and unnecessarily restrict individual liberty” (Pg. 4)
*“Maryland, the state’s attorney summoned parents of more than 1,600 children to court, giving them a choice between vaccinating their children and facing penalties of up to ten days in jail and fifty dollars a day in fines.” (Pg. 7)
*“Three key factors determine the percentage of the population that must be immunized in order to reach the herd immunity threshold: (1) the degree of the disease’s infectiousness; (2) the population’s vulnerability; and (3) the environmental conditions.” (Pg. 8)
*“The Court explained that the state had a duty to protect the welfare of the many and to refrain from subordinating their interests to those of the few.”(Pg. 12)
*“The Court determined that an individual’s belief qualified as a religious belief, if it was “sincere and meaningful” and it “occupied in the life of its possessor a place parallel to that filled by the God of those admittedly qualifying for the exemption.”” (Pg. 20)
*“The district court warned that while an individual may possess sincerely held beliefs, instead of being rooted in religious convictions, those beliefs may merely be framed in religious terms to feign compliance with the law.” (Pg. 21)
*“The Sherr case raises two issues. First, how much proof an individual must provide to demonstrate to the government the sincerity of the individual’s religious beliefs. Second, how public health officials in an emergency will determine quickly and fairly whether an individual meets the requisite burden of proof.” (Pg. 22)
*“Current state public health emergency laws inadequately address mass vaccination situations and leave wide-open the potential for the abrogation of individuals’ rights” (Pg. 29)
*“The model law, drafted by The Center for Law and the Public’s Health, at Georgetown and John Hopkins Universities, seeks to “grant public health powers to state and local public health authorities to ensure strong, effective, and timely planning, prevention, and response mechanisms to public health emergencies (including bioterrorism) while also respecting individual rights.” (Pg. 31)
*“Additionally, MSEHPA fails to address the need for a consistent and coordinated nationwide approach to mass vaccination in a multi-state emergency…..”To prevent the spread of contagious or possibly contagious disease the public health authority may isolate or quarantine . . . persons who are unable or unwilling for reasons of health, religion, or conscience to undergo vaccination.”‘ (Pg. 31)
*“The Public Health Emergency Medical Countermeasures Enterprise (“PHEMCE”)”  is likely the most appropriate government body to be in charge of implementing the new informed consent requirements, the medical and religious exemptions, and the right of refusal conditioned on a discretionary requirement of isolation or quarantine” (Pg. 35)
*[[Bioterrorism]], [[Public Health]], [[Vaccination]], [[Law Enforcement]], [[CDC]], [[Quarantine]], [[Pandemic]]

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